ahirc nashville ppt
TRANSCRIPT
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Monday November 14, 2011
Presented by: Jim Brown
National Director of Health Services
The Actors Fund
[email protected] x265
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Children under age 19 with pre-existingconditions cant be denied coverage.
Young adults up to age 26 can stay on or enrollin their parents coverage.
Insurers cant retroactively cancel the policiesof people who get sick.
Insurers cant impose lifetime dollar limits onmedical benefits.
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Uninsured people with pre-existingconditions may be eligible for coveragethrough PCIP.
Pre-Existing Condition Insurance Planhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-
plan/tn.htmlHelp for the uninsured with pre-existing medical conditions thru a
temporary high-risk pool until January, 2014
http://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.html -
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Medicare recipients in the coverage gap ordonut hole will receive 50% off drugs
Annual wellness visits and certain preventive
services will be free for Medicare recipients.
Increased funding to Community Health Centers
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Insurers cant refuse coverage to anyone. Most people will be mandated to have coverage or
pay a penalty.
New insurance marketplaces, called Exchanges, will
offer insurance to those who dont get it elsewhere. Subsidies will be available to people who buy
insurance through an exchange with income lessthan 400% of the Federal Poverty Level. ($43,320)
Employers with 50 or more employees who dontoffer insurance will be fined.
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All new plans will offer at a minimum anessential benefits package which limits out-of-pocket medical expenses.
Including: Ambulatory care
Emergency care and Hospitalization
Maternity and newborn care
Mental health and substance abuse Prescription drugs
Preventive and wellness services
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If your income is below $43,320 (single), youwill receive a subsidy to buy insurance throughan Exchange.
Subsidies will cap the amount you spend onpremiums in relation to your total income.
Subsidies will also cap your annual out-of-pocket medical costs.
Example: a person who makes $21,000/yr will have theirpremiums capped at 6.3% of their income, and their annualout-of-pocket medical costs will be limited to $1,983/yr(excluding premiums).
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Under age 30: high-deductible plan option
(2014). Prevention benefits and 3 primary
care visits are exempt from deductible.
Under age 26 on family plan as mentioned.
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If you have a new policy that began on or after9/23/2010, you can get certain preventiveservices for free:
Blood pressure, diabetes & cholesterol testsBreast, colon & cervical cancer screenings
Vaccines, immunizations & flu shots
HIV & STD testing
Screenings for healthy pregnanciesWell-child visits
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Available beginning 2010 tax year
Employers with fewer than 25 FTEs employees withaverage wages of less than $50,000 that purchase
health insurance for employees are eligible for thetax credit
To be eligible, employer must offer a group healthplan & contribute at least 50% of premium cost
2010-2013: credit max is 35% of employercontribution (25% for tax exempt/non-profits); willincrease to 50% (35% for non-profits) in 2014
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Artists Health Insurance Resource Center:www.ahirc.org
Office of Consumer Information and Insurance
Oversight: www.hhs.gov/ociio Federal health care reform website:
www.healthcare.gov
Kaiser Family Foundation: www.kff.org
http://www.ahirc.org/http://www.hhs.gov/ociiohttp://www.healthcare.gov/http://www.kff.org/http://www.kff.org/http://www.healthcare.gov/http://www.hhs.gov/ociiohttp://www.ahirc.org/ -
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Employment-related coverage Purchase private plans Government-subsidized programs
If you leave/get laid off from a job COBRA Continuation of employer benefitsfor at least 18 months60 days to decide/elect coverageSticker Shock guaranteed coverage, butcan be expensive. Pay full premium, at grouprate.
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Colleges & Universities Alumni Associations
Association Plans
Chambers of Commerce
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Words to Know HMO, PPO, HSA, High
Deductible or Catastrophic Coverage
Choose a carrier & type of policy to meetyour needs and your budget.
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http://www.ehealthinsurance.com/http://www.ehealthinsurance.com/ -
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Householdsize Annual income Monthly income1 $10,830 $9032 14,570 1,214
3 18,310 1,5264 22,050 1,838
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http://www.tn.gov/tenncare/forms/tenncareoverview.pdf
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http://www.tn.gov/tenncare/tenndercarehttp://www.tn.gov/tenncare/tenndercarehttp://www.covertn.gov/index.htmlhttp://www.covertn.gov/index.html -
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http://www.covertn.gov/web/cover_kids.htmlhttp://www.covertn.gov/web/cover_kids.html -
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http://www.covertn.gov/web/cover_rx.htmlhttp://www.covertn.gov/web/cover_rx.html -
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$4 Generics @ Target and Walmart
Pharmacy Checker
www.pharmacychecker.com
Partnership for Prescription Assistance
www.pparx.org
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http://www.covertn.gov/web/pcip_chart.pdfhttp://www.covertn.gov/web/pcip_chart.pdfhttp://www.covertn.gov/web/pcip_chart.pdfhttp://www.covertn.gov/web/pcip_chart.pdf -
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Sliding-scale clinics Health Center Program: ask.hrsa.gov/pc
Vine Hill Clinic
http://www.uchshealth.org/clinics
United Neighborhood Health Services 10 locations
http://www.unitedneighborhood.org
Siloam Health Care Centerhttp://www.siloamhealth.org/
http://www.uchshealth.org/clinicshttp://www.uchshealth.org/clinicshttp://www.unitedneighborhood.org/http://www.unitedneighborhood.org/http://www.siloamhealth.org/http://www.siloamhealth.org/http://www.siloamhealth.org/http://www.unitedneighborhood.org/http://www.uchshealth.org/clinics -
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ADAP HIV+ or AIDS Medications
1-800-525-2437
The National Breast & Cervical CancerProgram Participating providers
Income: up to 250% of FPL http://health.state.tn.us/BCC/index.htm
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Dental discount plans and dental insurance
Dental schools Meharry Medical College School of Dentistry
http://www.mmc.edu/education/dentistry/patientcare.html
Negotiate with your dentist
Many of the Community Clinics have low-cost or free dental clinics for people withlow incomes.
http://www.mmc.edu/education/dentistry/patientcare.htmlhttp://www.mmc.edu/education/dentistry/patientcare.htmlhttp://www.mmc.edu/education/dentistry/patientcare.htmlhttp://www.mmc.edu/education/dentistry/patientcare.html